Endocardial pacing relating to conduction abnormalities

Abstract

Various systems, methods and arrangements are implemented in connection with ventricular pacing. One such method relates to a method for use in connection with ventricular pacing of a left ventricle of a heart from a pacing lead located in the right ventricle. Ventricular function of the heart is sensed. The sensed ventricular function is used to determine whether a conduction abnormality exists. The ventricular pacing is provided in response to determining a conduction abnormality exists and the ventricular pacing is inhibited in response to determining a conduction abnormality does not exist.

What is claimed is: 
     
       1. A system, comprising:
 a sensor configured to sense a ventricular function of the heart; 
 a processing circuit configured to determine whether a conduction abnormality exists using information about the ventricular function of the heart obtained via the sensor; 
 an electrostimulation circuit configured to generate ventricular electrostimulation in response to a determination by the processor circuit that a conduction abnormality is present, the ventricular electrostimulation for delivery at or near a bundle of His via at least two electrodes and including at least partially concurrent opposite polarity electrostimulation pulses; 
 wherein the processing circuit is configured to determine whether the conduction abnormality exists by using at least an electrogram fractionation. 
 
     
     
       2. The system of  claim 1 , wherein the electrostimulation circuit is configured to inhibit generation of the electrostimulation for delivery at or near the bundle of His in response to a determination by the processor circuit that the conduction abnormality is absent. 
     
     
       3. The system of  claim 1 , wherein the at least partially concurrent opposite polarity electrostimulation pulses comprise a first pulse configured for delivery via a first electrode and a second pulse configured for delivery via a second electrode. 
     
     
       4. The system of  claim 1 , wherein the sensor, the processing circuit, and the electrostimulation circuit are included as a portion of an implantable assembly. 
     
     
       5. The system of  claim 1 , wherein the processing circuit is configured to determine whether a conduction abnormality exists by using at least a QRS width. 
     
     
       6. The system of  claim 1 , wherein the processing circuit is configured to determine whether a conduction abnormality exists by using at least a maximum rate of change in pressure seen in the left ventricle. 
     
     
       7. A method, comprising:
 sensing a ventricular function of the heart; 
 determining whether a conduction abnormality exists using information obtained via sensing the ventricular function of the heart, the determining whether the conduction abnormality exists including using at least an electrogram fractionation; 
 generating ventricular electrostimulation in response to a determination that a conduction abnormality is present, the ventricular electrostimulation generated for delivery at or near a bundle of His via at least two electrodes and including at least partially concurrent opposite polarity electrostimulation pulses. 
 
     
     
       8. The method of  claim 7 , wherein the generation of the electrostimulation for delivery at or near the bundle of His is inhibited in response to a determination that the conduction abnormality is absent. 
     
     
       9. The method of  claim 7 , wherein the at least partially concurrent opposite polarity electrostimulation pulses comprise a first pulse for delivery to a first electrode and a second pulse for delivery to a second electrode. 
     
     
       10. The method of  claim 7 , wherein determining whether a conduction abnormality exists includes using at least a QRS width. 
     
     
       11. The method of  claim 7 , wherein determining whether a conduction abnormality exists includes using at least a maximum rate of change in pressure seen in the left ventricle. 
     
     
       12. The method of  claim 7 , wherein the generation of the electrostimulation for delivery at or near the bundle of His is inhibited in response to sensing an intrinsic activation. 
     
     
       13. A processor-readable medium including instructions that, when performed by a processor, cause the processor to:
 sense a ventricular function of the heart; 
 determine whether a conduction abnormality exists, using information obtained via sensing the ventricular function of the heart, and using information about an electrogram fractionation; 
 generate ventricular electrostimulation in response to a determination that a conduction abnormality is present, the ventricular electrostimulation for delivery at or near a bundle of His via at least two electrodes and including at least partially concurrent opposite polarity electrostimulation pulses. 
 
     
     
       14. The processor-readable medium of  claim 13 , wherein the instructions that cause the processor to generate the electrostimulation for delivery at or near the bundle of His includes instructions to inhibit the generation of the etectrostimulation in response to a determination that the conduction abnormality is absent. 
     
     
       15. The processor-readable medium of  claim 13 , wherein the instructions to generate the at least partially concurrent opposite polarity electrostimulation pulses includes instructions to generate pulses comprise first pulse for delivery via a first electrode and a second pulse for delivery via a second electrode. 
     
     
       16. The processor-readable medium of  claim 13 , wherein the instructions to determine whether a conduction abnormality exists includes instructions to determine whether a conduction abnormality exists using at least a QRS width. 
     
     
       17. The processor-readable medium of  claim 13 , wherein the instructions to determine whether a conduction abnormality exists includes instructions to determine whether a conduction abnormality exists using at least a maximum rate of change in pressure seen in the left ventricle. 
     
     
       18. The processor-readable medium of  claim 13  wherein the instructions that cause the processor to generate the electrostimulation for delivery at or near the bundle of His includes instructions to inhibit the generation of the electrostimulation in response to a detection of an intrinsic activation.